Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of th
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CASE REPORT
Treatment options and long-term outcomes in pediatric spinal cord vascular malformations: a case report and review of the literature Helen J. Zhang 1 & Nicole Silva 2 & Elena Solli 2 & Amanda C. Ayala 3 & Luke Tomycz 4 & Catherine Christie 4 & Catherine A. Mazzola 4 Received: 14 September 2019 / Accepted: 15 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract A 16-month-old female was admitted for prolonged fever, gait ataxia, and neurogenic bowel and bladder. Neurological exam was significant for decreased sensory and motor functions in bilateral lower extremities. Initial MRI showed a thoracic spine hematoma and diagnostic angiogram revealed a large AVM and aneurysm. The patient underwent surgical resection of the hematoma and AVM, as well as clipping and later endovascular coiling of the aneurysm. Due to significant hemorrhage perioperatively, she developed spastic paraplegia improved by baclofen and onabotulinumtoxin A injections. The aims of this paper were to conduct a systematic review of the literature on pediatric spinal cord vascular malformations and analyze trends in treatment options and long-term neurological outcomes. PubMed searches were conducted using keywords “pediatric spinal vascular malformation” and “pediatric spinal AVM”, yielding 34 results after abstract screening and cross-reference. Endovascular embolization was determined to have better long-term outcomes, with 10/19 (52.6%) patients with postoperative complications associated with open vascular surgeries. Open versus endovascular surgical decisions can be difficult with unique spinal AVM pathologies in pediatric patients. Important considerations such as size, location, neurological deficits, and risk of rupture are important factors to consider in treating these patients. We recommend endovascular treatment as a first-line approach due to lower risk of hemorrhage and postoperative deficits. Keywords Arteriovenous malformation . Spinal cord hemorrhage . Spastic paraplegia . Endovascular embolization
Introduction Spinal vascular malformations are a heterogenous group of blood vessel disorders that affect the spinal cord parenchyma either directly or indirectly [4]. This group consists of spinal arteriovenous malformations (AVMs), dural arteriovenous fistulas (AVF), spinal hemangiomas, cavernous angiomas, and aneurysms, the most common of which are AVMs and AVFs.
* Helen J. Zhang [email protected] 1
Brown University, 69 Brown Street, Providence, RI 02912, USA
2
Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
3
Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, USA
4
New Jersey Pediatric Neuroscience Institute, 131 Madison Avenue, Morristown, NJ 07960, USA
There are four subcategories of spinal vascular malformations. Type I describes spinal dural AVMs that result from abnormal connections in the spinal canal dural covering. These form spontaneously during adulthood and usually do not result in ruptures and subsequent hemorrhaging,
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